AUCTORES
Globalize your Research
Review Article | DOI: https://doi.org/10.31579/2690-1919/519
1SBALAGRM-SOFIA, Sofia, Bulgaria. 2Sofia University "St. Kliment Ohridski", Cytology-Histology and Embryology, Sofia, Bulgaria. 3Bulgarian Academy of Science, Institute of Molecular Biology, Sofia, Bulgaria.
*Corresponding Author: Iavor K. Vladimirov., SBALAGRM-SOFIA, Sofia, Bulgaria.
Citation: Iavor K. Vladimirov, Desislava Tacheva, Evan Gatev and Martin Vladimirov, (2025), Will non-Ultrasound Monitoring Ovarian Stimulation
(NUMOS) Make Freeze all for all? - cost-Effectiveness Analysis, J Clinical Research and Reports, 19(3); DOI:10.31579/2690-1919/519
Copyright: © 2025, Iavor K. Vladimirov. This is an open access article distributed under the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 20 March 2025 | Accepted: 25 March 2025 | Published: 03 April 2025
Keywords: ovarian stimulation monitoring; in vitro fertilization; fet; numos; cost effectiveness
Assisted reproductive technologies are one of the most rapidly developing fields in medicine. In recent decades, new technologies and methods have been introduced that have made it possible to increase the success rate of infertility treatment and reduce its costs. Using the vitrification method, it has become feasible to successfully freeze oocytes and embryos, with the freeze-all embryos strategy becoming increasingly popular, as it presents a high success rate, various clinical advantages, and reduced patient risk, especially for patients with a high ovarian response. A major challenge with this strategy, compared to the generally accepted classic approach for the so-called fresh embryo transfer, is the additional costs resulting from freezing/thawing the embryos and the additional visits related to preparation for embryo transfer. A solution to this problem would be to use the non-ultrasound monitoring of ovarian stimulation (NUMOS) approach, allowing to significantly reduce the costs of infertility treatment through IVF procedure, the direct medical and non-medical costs, as well as the indirect costs. NUMOS in combination with progestin (PPOS) is an appropriate protocol when applying the freeze-all strategy. This method also enables the active entry of artificial intelligence (AI) into the treatment process. It is anticipated to usher a shift in the established paradigm in medicine, which should not be seen as a revolution, but rather as part of an evolutionary process.
Every innovation in assisted reproduction aims to increase the success rate and reduce the risk to the patient and the cost of the service. It is in the interest of both the patient and society to reduce the direct and indirect costs of treating infertility through in vitro procedures. For this reason, with the use of telemedicine and various technologies, different methods and approaches are being used to reduce these treatment costs. A successful example of this strategy is the method, developed by Gerris et al. [1], of self-operated endovaginal telemonitoring (SOET), which enables patients to perform vaginal sonographies from their own homes. This innovation gives the patient the option not to come to the clinic as often. Applying telemedicine elements through SOET in COS monitoring during IVF treatment saves the patients and their partners time and money. Structured communication via email or other means allows the patient to be treated in a clinic of their choice, due to the remote nature of the procedure. This approach increases patient autonomy. Another approach that aims to reduce costs in ovarian stimulation, is measuring E2 saliva levels. A number of studies have shown that a substantial correlation coefficient ranging from 0.68 to 0.91 was discovered between serum and salivary E2 concentrations [2,3]. This patient-friendly non invasive method could allow frequent hormone monitoring without the need for appointments at the clinic and for phlebotomy, thus resulting in more convenience for both the clinics and the patients [4]. Other studies found that estrone-3-glucuronide (E1-3G) urinary levels are a function of increasing estradiol levels during ovarian stimulation [5,6,7,8]. An advantage of the method is that E1-3G in urine can be determined with a small portable analyzer by patients at home. The established correlation of E2 and E1-3G in this method is in the range of 0.76-0.81 [9,10]. Based on these results, a new approach for OS monitoring was developed, called Controlled Ovarian Stimulation by Self-Determination of Estrone-3 Glucuronide and Single Ultrasound (COSSESU). The growth dynamics of E1-3G during stimulation are used as a marker for follicle growth, accompanied at the end of stimulation with a single ultrasound examination and determination of serum hormone levels. As a result of our extensive analysis and research and our experience with COSSESU, Auctores Publishing – Volume 19(2)-519 www.auctoresonline.org ISSN: 2690-1919 Page 1 of 5 J. Clinical Research and Reports we have developed a new method of ovarian stimulation monitoring without the use of ultrasound and studying the dynamics of changes in hormones in the blood, the so-called Non-Ultrasound Monitoring of Ovarian Stimulation (NUMOS). In this way, direct medical and nonmedical costs, as well as indirect costs, can be significantly reduced [11]. In this article, the implementation of NUMOS combining with Copy rights@ Iavor K. Vladimirov, progestin priming ovarian stimulation (PPOS) protocol to freeze embryos will be examined, as well as a comparative analysis of freeze-all and fresh ET strategies will be provided, and the extent to which NUMOS can reduce the cost of infertility treatment by IVF procedure will be determined.
Figure 1: Non-Ultrasound Monitoring of Ovarian Stimulation.
Non-Ultrasound Monitoring of Ovarian Stimulation (Global Reproductive Health 09(04):1-7).
The method includes several key components:
-Choice of stimulation protocol. PPOS is a suitable protocol, because it is equally successful compared to others, easy to apply, and more patient-friendly. Use of GnRH agonist as an ovulation trigger and mandatory embryo freezing, significantly reduce the risk of OHSS [12].
-Starting doses – determined on the basis of a preliminary assessment of the ovarian reserve, carried out in the previous 3 months. Based on the patient's age, BMI, AFC, AMH, FSH, and smoking [13], the starting dose of gonadotropins can be determined, which further reduces the risk of OHSS and cancellation of stimulation due to unsatisfactory response. -Stimulation with fixed doses – this makes the procedure easier for patients and does not reduce the effectiveness of the treatment, compared to adjusting the doses depending on the ovarian response [14,15].
-Control of the adequacy of the ovarian response - based on monitoring the stimulation and the dynamics of E1-3G in urine, by regular determination of E1-3G in urine independently by the patients at home. This is done with the help of a small portable analyzer, which is easy to use and takes a short time to read E1-3G in the sample. [16,17]
-Determining the day for follicular puncture – based on the length of the menstrual cycle [11]. This gives us the opportunity to optimize the work in the clinic, as well as pre-calculate the stimulation doses that must be provided.
Cost-effectiveness in freeze-all and fresh ET strategies using NUMOS with PPOS protocol.
The policy of freezing all embryos requires additional costs to freeze and thaw the embryos, as well as a new FET cycle, which, in turn, means additional clinic visits. Therefore, the cost of the all-embryo freezing strategy is expected to be higher than the conventional strategy and its adoption would only be justified if there is cost-effectiveness. A proper cost-effectiveness analysis should take into account other important parameters, such as the cost of potential complications for the mother and baby (such as OHSS, obstetric and neonatal complications). The profitability aspects of the freeze-all policy are still under debate. Some authors maintain that the freeze-all strategy is cost-effective based on a
higher success rate [18,19], while others disagree [20,21]. Research and discussion continue, and most authors are of the opinion that the success
rate of base CLBR when applying the freeze-all policy is comparable to that when fresh ET is implemented. If we assume that the success rate of both approaches is approximately equal [22,23,24], then the sole factor that remains is the cost of the treatment. The main advantage of the fresh ET policy is the lower price compared to Freeze all, due to the additional costs for freezing, storing and thawing of the embryos, as well as the preparation of the patient cycle for thawed ET. Comparative studies between the two approaches found significantly fewer costs for IVF treatment using the Fresh ET policy with GnRH agonist and GnRH antagonist protocols. With the introduction of PPOS, which requires freezing of embryos, the cost of medication is significantly reduced. Although the cost of treatment using the PPOS protocol is higher compared to a short GnRH agonist, it is still lower compared to the application of GnRH antagonist protocols [25]. All these comparatives analyze are made on the basis of market-determined prices, as well as the price that the patient pays for the service. However, there is an alternative perspective – pricing based on the real value (what it costs the clinic) of the freezing and thawing procedure. Using these criteria, Papaleo et al. [26], found that the additional costs of FET for drugs were 34 euros and for freezing/thawing each blastocyst were within 57 euros. Another study [27], providing detailed estimates of costs for the different stages of infertility treatment through IVF technologies, found that the costs (including costs of the fertility department and laboratory costs) for carrying out FET were 202 euros more compared to fresh ET. The authors report that 18.9% of IVF procedures resulted in cryopreservation of residual embryos, with the cost of cryopreservation of residual embryos being 141-173 euros. This increases the cost of infertility treatment by 29 euro per oocyte aspirated. Additional costs that would be involved after a cryopreserved embryo transfer leading to a positive pregnancy outcome totaled 111 euro. This is due to the prolonged administration of progesterone in artificially regulated cryopreserved cycles. The price of IVF treatment is partly determined by direct and indirect costs. Direct costs are known and can be easily ascertained. These include the costs of doctor consultations, medication, ultrasound scans, laboratory tests, ART procedures (follicular puncture, anesthesia, laboratory costs of sperm processing, IVF/ICSI fertilization, embryo culture, freezing and embryo transfer), hospital fees, and administrative fees. From an analysis by Collins [28], it is evident that the cost of the IVF procedure varies widely, from US$ 1,272 in Iran and Pakistan to US$ 6,361 to US$ 9,547 in the United States, respectively. Similar disproportions in the price of the IVF procedure were also reported by other authors, who established an average price for the USA for 2006 of $12,513, while in Japan the average price was $3,956. Medication costs represent a significant part of the total cost of treatment in all countries. The proportion was highest in Canada, where drug costs were 41.5% of total treatment costs, and lowest in Japan, where they totaled 13% of treatment costs. These differences in drug costs partly stem from the different market prices of commonly used drugs, partly from differences in prescribing patterns, i.e. fewer gonadotropins per stimulated cycle used in one country versus another, etc. [29]. The direct non medical and indirect costs related to the IVF procedure mainly include costs related to loss of working time and travel to the treatment center, food, and hotel accommodation. According to some authors, indirect costs are much lower than direct costs and are therefore considered negligible [30]. However, according to other authors, direct non-medical costs and indirect costs of IVF treatment account for 45%-52% of total costs [20]. A study by Wu et al. [31] showed that in a period of 18 months, the patient devoted 162 hours to the treatment of infertility by IVF method, which is equal to 20.25 days, with an 8-hour working day. A study by Bouwmans et al. [32] shows that the patient is absent from work for the realization of the IVF/ICSI procedure an average of 23 hours, which, calculated on a salary basis, is a loss of productivity within 596 euro. Another study [33] showed that depending on the distance to the clinic, patients could spend between 15 and 75 hours on travel, with the main costs being food and accommodation, ranging from 104 – 703 euro. Additional costs are consistently cited as a reason why patients choose not to seek infertility counseling and treatment or discontinue treatment before pregnancy is achieved [34,35], this is also found in countries where infertility treatment services are subsidized by health insurance systems [36,37]. One of the main reasons for these decisions is the high indirect and time costs that patients have to take into account during the treatment. A study by Le et al. [22] is one of the few studies in which indirect costs were included and analyzed alongside direct medical costs. This is a randomized controlled trial (RCT) that included 782 non-PCOS patients with the aim that the strategy be more cost-effective from a patient perspective than fresh embryo transfer (ET). The analysis found that the mean total costs per couple did not differ significantly when comparing the freeze-all policy groups compared to the fresh ET group. However, there is an difference of 393.6 euro less, when applying fresh ET. The study did not specify how many visits per procedure, on average, patients made. But this can be established on the basis of the presented direct costs for examinations in both groups, the price list from the appendix, information on the type of protocol, and the number and type of examined hormones in the serum [38], namely antagonist protocol and determination of hormones (E2 and P) at each ultrasound examination. From the analysis, it can be determined that patients had 6-8 visits per procedure, and FET patients had to make 1 visit more. Respectively, approximately 2/3 of the visits (4-6 visits) were related to OS monitoring. This corresponds to established practice for the number of visits when using an antagonist protocol, including visits for follicular puncture and ET. Along with its scientific advantages, this study provides specific information about direct non-medical and indirect costs: 1,767.3 euros for freeze-all and 1,827.9 euros for fresh ET, which amounts to 45-52% of the total costs of the IVF treatment. The question arises, whether the application of NUMOS can reduce and by how much the cost of treating infertility through an IVF procedure? The answer to the question should take into account the market prices of services and medication, in this case in Vietnam, as well as the fact that using NUMOS is related to the freeze-all policy. The authors of the above study found that patients spent 3,905.8 euros when applying the classic method of OS monitoring, embryo freezing, and FET implementation. When applying NUMOS for monitored stimulation, visits for the entire IVF procedure would be reduced approximately three times, respectively patients would save 1000-1200 euros from direct non-medical and indirect costs. To these, we can add saved costs from ultrasound examinations and hormonal tests within 100-120 euros. Cost savings for the medications used in the antagonist protocol, when replaced with the PPOS protocol, would amount to 180-220 euros. From the calculation, it is clear that the application of the NUMOS method can reduce the cost of IVF treatment by 25-30%. Expressed in concrete terms based on the economic analysis of Le et al. [22], patients would save a minimum of 1,000 euros. This means that the costs of the whole procedure would fall within 2,900 euros when freezing all embryos, while with a fresh ET policy, the costs would be within 3,500 euros. This means that the Freeze all policy becomes financially more sound compared to the fresh ET policy. Another study by Maheshwari et al. [23] also found that a policy of freezing all embryos compared to fresh embryo transfer did not increase the delivery rate. The elective freeze (E-Freeze) trial was a pragmatic, multicentre, two-arm, parallel-group, non-blinded, randomized controlled trial, carried out in eighteen different clinics in the UK and included 619 couples that were randomized in fresh-embryo transfer arm and freeze-all arm groups. The authors conclude that, when efficacy, safety, and costs are considered, freeze-all policy is not better than fresh-embryo transfer. Looking closely at the information presented in the study, it can be found that treatment costs under the freeze-all policy are indeed higher on average by £322 compared to fresh ET – respectively £1538 and £1216. However, fresh ET cases included significantly more cases of OHSS and had more outpatient visits and longer inpatient stays than participants in the freeze-all group. The average additional cost required to treat OHSS in the allocation was £17 for frozen embryo transfer and £201 for fresh embryo transfer. Moreover, when costs were recalculated according to NHS prices, the results were similar, respectively £3431 for the group with freezing all embryos and £3574 for the group with fresh embryo transfer. Compared to the study by Lee et al. [22], the direct medical costs of ovarian stimulation (OS) monitoring were significantly higher than the indirect costs. Respectively, the cost of a visit with an ultrasound examination is £160-220 and £40-60 for the examination of each hormone during stimulation monitoring. The information received from patients about total travel costs and time costs per visit averaged £58. Total time costs are based on (ASHE) calculations. If NUMOS is applied to monitor stimulation, the reduction in visits will significantly reduce direct medical costs. By reducing visits to 3-5 during OS, the costs will be reduced by a minimum of 800-1000 pounds, and this will be mainly coming out of direct medical costs. Therefore, in this case, applying a NUMOS approach for monitored stimulation using the Freeze all strategy also will be cost-effective, compared to a fresh ET policy. From the presented facts and results, it is clear that applying the NUMOS method for monitoring ovarian stimulation can significantly reduce the costs of infertility treatment through the IVF method. They would be further reduced if the NUMOS method were combined with home-based monitoring of ovulation to time frozen embryo transfer (HOMET), the efficacy of which was established by Zaat et al [39]. I would refer to this strategy as Two Visits IVF (TV/IVF): first visit for follicular puncture and second visit for ET. Some colleagues may view this new approach with scepticism. Nevertheless, thanks to new technologies, telemedicine, and the active entry of artificial intelligence (AI) into assisted reproduction (ART), the TV/IVF approach is a reality. This will make infertility treatment more accessible and optimize the work of ART clinics.
NA
IKV: Design, conception, analysis and interpretation of data, drafting of article, writing - review & editing, supervision. DT: Design, drafting of article, funding acquisition. IG: Analysis and interpretation of data, writing - review & editing, visualization. MV: Conception, writing - review & editing, visualization. All authors approved the final manuscript. All authors contributed to the article and approved the submitted version.
Non
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The authors would like to thank all the medical staff in the SBALAGRM-SOFIA for their assistance in data collection.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
